Heparin

Full dose IV UFH has been commonly used in acute stroke therapy; however, no adequately designed trials have been conducted to establish its efficacy and safety. Current acute ischemic stroke treatment guidelines do not recommend routine, urgent, full dose anticoagulation with UFH or LMWHs due to the lack of a proven benefit in

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improving neurologic function and the risk of intracranial bleeding. Full dose UFH may prevent early recurrent stroke in patients with large-vessel atherothrombos-is or those thought to be at high-risk of recurrent stroke (i.e., cardioembolic stroke); however, more study is required.

The major complications of heparin include evolution of the ischemic stroke into a hemorrhagic stroke, bleeding, and thrombocytopenia. The occurrence of severe headache and mental status changes may indicate ICH. Signs of bleeding mirror those listed for alteplase therapy. The hemoglobin, hematocrit, and platelet count should be obtained at least every 3 days to detect bleeding and thrombocytopenia.

LMWHs and Heparinoids

TFull dose LMWHs and heparinoids are not recommended in the treatment of acute 7 1121

ischemic stroke. ' ' Studies with these agents have generally been negative and no convincing evidence exists that these agents improve outcomes after ischemic stroke. An increased risk of bleeding complications and hemorrhagic transformation have been observed.

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